UNIT : _________________________                                                      Muscat Private Hospital                                                           Effective Date_____________
MONTH: _______________________                                                                                                                                                        Page #: 1 of 1
                                                                                  INTERNAL AUDIT CHECKLIST
                                                                    IPSG 2 IMPROVE EFFECTIVE COMMUNICATION (b)
___________________________________
SIGNATURE (INTERNAL AUDITOR)                                                                                                                               Approved by: _________________________
                                                                                                                                                                              Quality Manager
___________________________________
SIGNATURE (EXTERNAL AUDITOR)
 SCORE OBTAINED:                                   MAXIMUM SCORE:
 QUALITY INDEX:                                    AVERAGE Q.I.:                                                                      SAMPLE SIZE:
                                                                     MRN:              MRN:             MRN:             MRN:             MRN:              MRN:
    AUDIT STRATEGIES USED :                                                                                                                                                  K E Y : Y - YES
     _ ___ PATIENT INTERVIEW                                                                                                                                                         N - No
    _____ STAFF INTERVIEWS                                                                                                                                                           NA - NOT APPLICABLE
    _____ PRACTICE OBSERVATION                                                                                                                                                       Q.I. - QUALITY INDEX
    _____ REVIEW NURSING RECORD                                      Date:             Date:            Date:            Date:            Date:             Date:
    _____ OTHERS ( specify_________)
                                                                                 NA    Y       N   NA   Y       N   NA    Y      N   NA    Y      N   NA     Y      N   NA            COMMENTS
                                       CRITERIA:                      Y      N
         Endorsement kardex maintained and
    1    completed on each shift?
         (ISBAR) Internal transfer form maintained and
    2    completed?
         (ISBAR) Multidisciplinary form Maintained
    3    whenever needed?
         Are the doctors using (ISBAR) clinical
    4    Handover of Care form whenever needed?
                         GRAND TOTÀL